Arthritis: Should I Have Knee Replacement Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Arthritis: Should I Have Knee Replacement Surgery?

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Get the facts

Your options

Don't have this
surgery. Instead, use other treatments, like exercise, weight loss (if you're overweight), medicines, or another
type of surgery.

Key points to remember

The decision you and your doctor make depends on your age,
health, and activity level, and on how much pain and disability you have.

Most people have knee replacement only when they can no longer
control
arthritis pain with medicine and other treatments and
when the pain really interferes with their lives.

Rehabilitation
after knee replacement requires daily exercises for several
weeks.

Most knee replacements last for at least 15 years. Some people need to have the knee replaced again.

If you wait so long to have a knee replacement that you have already lost much of your strength, endurance, and ability to be active, then after the surgery you might have a harder time returning to your normal activities.

Osteoarthritis is a
problem that affects all parts of the joint. For example, when cartilage breaks down, the
bones start to rub against each other. This
causes damage to tissue and bone. The symptoms of osteoarthritis include joint
pain, stiffness after inactivity, and limited motion.

Knee replacement surgery may be used when a person can no longer control knee pain with other treatments and when the pain disrupts his or her life.

The surgeon covers the ends of the
damaged thighbone and lower leg bone, and usually the kneecap, with artificial
(man-made) surfaces that are lined with metal and plastic. The artificial
pieces are usually cemented to the bones.

Rehabilitation, or rehab, is
usually intense after surgery. Most people start to walk with a walker or
crutches the day of surgery or the next day. And they begin physical therapy right away. Your
doctor may advise you to ride a stationary bike to strengthen your leg muscles
and improve how well you can bend your knee. Rehab will take several weeks, but
you should be able to start walking, climbing stairs, sitting in and getting up
from chairs, and doing other daily activities within a few days.

Surgery is only for people with severe
osteoarthritis who do not get pain relief from
medicine, home treatment, or other methods and who have lost a lot of
cartilage. Surgery relieves severe, disabling pain and may restore the knee's
ability to work properly.

There are a
number of treatments for arthritis in the knee that don't involve
surgery:

Medicine. If your pain is mild, over-the-counter pain medicines may help. These include acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory drugs, such as ibuprofen (for example, Advil, Motrin) or naproxen (for example, Aleve). But if these don't get rid of your pain, you may need a stronger prescription medicine. Be safe with medicines. Read and follow all instructions on the label.

Steroid shots. Steroid shots may provide rapid pain relief. But for some people, this benefit only lasts a few weeks.

Ice or heat.
Heat may help you loosen up your joints before an activity. Ice is a good pain
reliever after activity or exercise.

Exercise. Exercise helps because it makes your muscles
stronger, which lowers the stress on your knees. But make sure to talk to your
doctor about what kind of activity is best for you.

Losing weight, if you're overweight. Losing weight helps take some of the stress off of your joints.

Physical therapy. This includes specific exercises that can help you stretch and strengthen your muscles and reduce pain and stiffness.

Walking aids. There are many devices you can use to take some
of the stress off of your knee. These include crutches, walkers, braces, and
tape. You may also be able to reduce the stress on your knee by wearing the right shoes or by adding insoles to your shoes. Talk to your doctor or physical therapist about what would be best for you.

Some other things that you may try include:

Acupuncture. It involves putting very tiny needles into your skin at certain places on your body to try to relieve pain. Some people find that acupuncture
helps. But there is not a lot of medical research to support the use of acupuncture for knee arthritis.

Dietary supplements, such as glucosamine and chondroitin, fish oil, or SAM-e. Some people feel that these supplements help. But medical research does not prove that they work. Talk to your doctor before you take these supplements.

Most people have much less pain after
knee replacement surgery and are able to return to
many of their activities. But as with any surgery, there are some risks,
including:

Lack of good range of motion. After
surgery, some people can't bend their knee far enough to do their daily
activities, even after several weeks.

Dislocated kneecap. If this happens, the kneecap may move to
one side of the knee, and it will "pop" back when you bend your knee. It
usually needs to be treated with another surgery. But this problem is not
common.

Blood clots. These can be dangerous
if they block blood flow from the leg back to the heart or move to the lungs.
They are more common in older people, those who are very overweight, those who
have had blood clots before, and those who have cancer.

Wound-healing problems. These are more
common in people who take steroid medicines or who have diseases that affect
the immune system, such as
rheumatoid arthritis and
diabetes. People who have any sort of artificial
material in their bodies, including artificial joints, have a risk of infection
around the material. But infection is rare. There is also a small risk of
infection with any surgery.

Instability in the joint. The knee may be unstable or wobbly if the replacement parts are
not properly aligned. You may need a second surgery to align the parts
correctly so that your knee is stable.

The usual risks of general anesthesia. Problems from anesthesia are not common,
especially in people who are in good health overall. But all anesthesia has
some risk.

Problems after surgery

Serious joint infection. Within 3 months after surgery, 1 out of 100 people will get a serious infection. This means that 99 people out of 100 will not get an infection.footnote 10footnote 8, footnote 9

Heart attack. Within 3 months after surgery, 1 out of 100 people will have a heart attack. This means that 99 out of 100 will not have a heart attack.footnote 7, footnote 8, footnote 9

Blood clot in the lung. Within 3 months after surgery, 1 out of 100 people will have a life-threatening blood clot in the lung. This means that 99 out of 100 will not have a life-threatening blood clot in the lung.footnote 7, footnote 8, footnote 9

Death, which may or may not be caused by the surgery itself. Within 3 months after surgery, less than 1 out of 100 people will die. This means that more than 99 people out of 100 who had the surgery will not die within 3 months.footnote 7, footnote 9, footnote 8

Your knee won't bend as far as it did before you started
having knee problems.

You may need to avoid activities that put a
lot of stress on the joint, like running or playing tennis.

You may
eventually need another replacement, because the artificial joint can wear
out.

Try other treatment
Try other treatment

You can try exercise,
weight loss (if you're overweight), medicines, joint injections, or, in some cases, another type of surgery.

You can try using crutches,
braces, and other types of walking support to help ease the stress on your
knee.

You avoid the risks and side
effects of surgery.

You avoid months of physical therapy, although
exercise is still important.

The strong
medicines used for severe pain may cause constipation, mental confusion,
drowsiness, and nausea and vomiting.

Steroid injections can cause
pain and swelling in the knee.

There
are no bad effects from home treatments such as staying at a healthy weight,
exercising, and using heat and cold therapy.

If you decide to have surgery later, and your limited activity has already caused you to lose strength, flexibility, balance, or endurance, it may be harder to return to your normal activities.

Personal stories about knee replacement surgery for osteoarthritis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I've skied
competitively since I was 6 years old. In my 20s, I had several knee injuries
and surgeries. About 7 years ago, I started having a lot of pain in one knee,
and my doctor said the only surgery left to do was to replace the knee. If I
have the knee replaced, I won't be able to ski or run or do anything that puts
a lot of stress on it. I can't do any of those things now because of the pain
anyway. I don't know how I'm going to deal with that, since being an athlete
has always been a big part of who I am. I'm worried about having my knee
replaced when I'm so young, but with the amount of pain I'm having, I don't see
any other choice.

Chuck, age 45

The pain in
my knees, especially my left one, has gotten steadily worse in the last 20
years. The medicines just weren't working. It got so bad last year that I
gave up on my flower garden. My doctor and I discussed knee replacement, but I
consider that my last resort. My doctor and I developed a plan of swimming and
healthy eating habits that will help me take off the extra weight I've put
on. We agree that's the best thing I can do to keep my osteoarthritis from
getting worse. We're going to try some different medicines too.

Esmerelda, age
61

I feel like I'm too young to have my knee
replaced. But I definitely need something other than Tylenol for the pain. I
asked my doctor about my other options. She said we can try joint injections
and see how that works. I can always have the surgery later if I need it, but
I'd sure like to put it off for as long as I can. I'll see if these joint
injections make the pain better. My doctor says that as long as I can handle
the pain, we can hold off on the surgery.

George, age 57

I was an
avid tennis player for years, and it finally caught up with my knees. I had an
osteotomy years ago, and it helped for a while. But now so much of my time is
focused on the pain. I'm an active grandmother with no intention of missing out
on my grandkids' activities. I know that surgery will mean a long period of
exercising and rehabilitation, but it will be worth it to lose this stiffness
and discomfort.

Jean,
age 71

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have knee replacement surgery

Reasons not to have knee replacement surgery

I want to be able to do low-impact activities, such as swimming and golf, as well as chores and housework.

My knee doesn't really get in the way of the physical activities I like or need to do.

More important

Equally important

More important

I have more bad days than good.

I have more good days than bad.

More important

Equally important

More important

I'm not worried about the chance of needing another replacement surgery later in life.

I'm worried about needing another surgery in 10 or 20 years.

More important

Equally important

More important

I'm ready and willing to do several weeks of physical therapy after the surgery.

I don't want, or I won't be able, to have several weeks of physical therapy.

More important

Equally important

More important

I know that problems sometimes occur with surgery, but getting pain relief and getting back some use of my knee is worth the risk.

I'm very worried about problems from surgery.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having knee replacement surgery

NOT having knee replacement

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, Knee replacement surgery should be my first choice if I have osteoarthritis of the knee.

YesSorry, that's not correct. Knee replacement surgery should be considered only when other treatments-such as exercise, medicines, physical therapy, and a change in your daily activities-haven't worked to ease your symptoms.

NoYou're right. Knee replacement surgery should be considered only when other treatments-such as exercise, medicines, physical therapy, and a change in your daily activities-haven't worked to ease your symptoms.

I'm not sureIt may help to go back and read "Get the Facts." Knee replacement surgery should be considered only when other treatments haven't worked to ease your symptoms.

2.2, I will be able to return to all my normal activities right after I have this surgery.

YesSorry, that's not correct. Rehabilitation after knee replacement surgery is usually intense and requires daily exercises for several weeks.

NoYou are right. Rehabilitation after knee replacement surgery is usually intense and requires daily exercises for several weeks.

I'm not sureIt may help to go back and read "Get the Facts." Rehabilitation after knee replacement surgery is usually intense and requires daily exercises for several weeks.

3.3, Although most surgeries last for at least 15 years, I may need to have my knee replaced again.

YesYou are right. Most knee replacement surgeries last for at least 15 years. But some people do need to have another replacement later.

NoSorry, that's not right. Most knee replacement surgeries last for at least 15 years. But some people do need to have another replacement later.

I'm not sureIt may help to go back and read "Get the Facts." Most knee replacement surgeries last for at least 15 years. But some people do need to have another replacement later.

Mahomed NN, et al. (2005). Epidemiology of
total knee replacement in the United States Medicare population. The Journal of Bone and Joint Surgery. American Volume, 87(6): 1222-1228. http://dx.doi.org/10.2106/JBJS.D.02546 Accessed May 25, 2016.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Arthritis: Should I Have Knee Replacement Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery to replace your knee.

Don't have this
surgery. Instead, use other treatments, like exercise, weight loss (if you're overweight), medicines, or another
type of surgery.

Key points to remember

The decision you and your doctor make depends on your age,
health, and activity level, and on how much pain and disability you have.

Most people have knee replacement only when they can no longer
control
arthritis pain with medicine and other treatments and
when the pain really interferes with their lives.

Rehabilitation
after knee replacement requires daily exercises for several
weeks.

Most knee replacements last for at least 15 years. Some people need to have the knee replaced again.

If you wait so long to have a knee replacement that you have already lost much of your strength, endurance, and ability to be active, then after the surgery you might have a harder time returning to your normal activities.

FAQs

What is osteoarthritis?

Osteoarthritis is a
problem that affects all parts of the joint. For example, when cartilage breaks down, the
bones start to rub against each other. This
causes damage to tissue and bone. The symptoms of osteoarthritis include joint
pain, stiffness after inactivity, and limited motion.

What is knee replacement surgery?

Knee replacement surgery may be used when a person can no longer control knee pain with other treatments and when the pain disrupts his or her life.

The surgeon covers the ends of the
damaged thighbone and lower leg bone, and usually the kneecap, with artificial
(man-made) surfaces that are lined with metal and plastic. The artificial
pieces are usually cemented to the bones.

Rehabilitation, or rehab, is
usually intense after surgery. Most people start to walk with a walker or
crutches the day of surgery or the next day. And they begin physical therapy right away. Your
doctor may advise you to ride a stationary bike to strengthen your leg muscles
and improve how well you can bend your knee. Rehab will take several weeks, but
you should be able to start walking, climbing stairs, sitting in and getting up
from chairs, and doing other daily activities within a few days.

Surgery is only for people with severe
osteoarthritis who do not get pain relief from
medicine, home treatment, or other methods and who have lost a lot of
cartilage. Surgery relieves severe, disabling pain and may restore the knee's
ability to work properly.

What other surgeries are used to treat osteoarthritis?

Besides knee replacement, the other types of surgeries used are:

Other types of surgery

Surgery

Description

Arthroscopy

Arthroscopy may be used to smooth a rough joint surface or remove loose cartilage or
bone fragments. But it is not usually recommended for osteoarthritis of the knee.

Osteotomy

This surgery corrects knee
problems such as bowleg and knock-knee. It is usually done for younger, active
people who have mild arthritis and who want to delay knee replacement.

What other treatments are available?

There are a
number of treatments for arthritis in the knee that don't involve
surgery:

Medicine. If your pain is mild, over-the-counter pain medicines may help. These include acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory drugs, such as ibuprofen (for example, Advil, Motrin) or naproxen (for example, Aleve). But if these don't get rid of your pain, you may need a stronger prescription medicine. Be safe with medicines. Read and follow all instructions on the label.

Steroid shots. Steroid shots may provide rapid pain relief. But for some people, this benefit only lasts a few weeks.

Ice or heat.
Heat may help you loosen up your joints before an activity. Ice is a good pain
reliever after activity or exercise.

Exercise. Exercise helps because it makes your muscles
stronger, which lowers the stress on your knees. But make sure to talk to your
doctor about what kind of activity is best for you.

Losing weight, if you're overweight. Losing weight helps take some of the stress off of your joints.

Physical therapy. This includes specific exercises that can help you stretch and strengthen your muscles and reduce pain and stiffness.

Walking aids. There are many devices you can use to take some
of the stress off of your knee. These include crutches, walkers, braces, and
tape. You may also be able to reduce the stress on your knee by wearing the right shoes or by adding insoles to your shoes. Talk to your doctor or physical therapist about what would be best for you.

Some other things that you may try include:

Acupuncture. It involves putting very tiny needles into your skin at certain places on your body to try to relieve pain. Some people find that acupuncture
helps. But there is not a lot of medical research to support the use of acupuncture for knee arthritis.

Dietary supplements, such as glucosamine and chondroitin, fish oil, or SAM-e. Some people feel that these supplements help. But medical research does not prove that they work. Talk to your doctor before you take these supplements.

What are the risks of knee replacement surgery?

Most people have much less pain after
knee replacement surgery and are able to return to
many of their activities. But as with any surgery, there are some risks,
including:

Lack of good range of motion. After
surgery, some people can't bend their knee far enough to do their daily
activities, even after several weeks.

Dislocated kneecap. If this happens, the kneecap may move to
one side of the knee, and it will "pop" back when you bend your knee. It
usually needs to be treated with another surgery. But this problem is not
common.

Blood clots. These can be dangerous
if they block blood flow from the leg back to the heart or move to the lungs.
They are more common in older people, those who are very overweight, those who
have had blood clots before, and those who have cancer.

Wound-healing problems. These are more
common in people who take steroid medicines or who have diseases that affect
the immune system, such as
rheumatoid arthritis and
diabetes. People who have any sort of artificial
material in their bodies, including artificial joints, have a risk of infection
around the material. But infection is rare. There is also a small risk of
infection with any surgery.

Instability in the joint. The knee may be unstable or wobbly if the replacement parts are
not properly aligned. You may need a second surgery to align the parts
correctly so that your knee is stable.

The usual risks of general anesthesia. Problems from anesthesia are not common,
especially in people who are in good health overall. But all anesthesia has
some risk.

What do numbers tell us about the benefits and risks of knee replacement?

Problems after surgery

Serious joint infection. Within 3 months after surgery, 1 out of 100 people will get a serious infection. This means that 99 people out of 100 will not get an infection.108, 9

Heart attack. Within 3 months after surgery, 1 out of 100 people will have a heart attack. This means that 99 out of 100 will not have a heart attack.7, 8, 9

Blood clot in the lung. Within 3 months after surgery, 1 out of 100 people will have a life-threatening blood clot in the lung. This means that 99 out of 100 will not have a life-threatening blood clot in the lung.7, 8, 9

Death, which may or may not be caused by the surgery itself. Within 3 months after surgery, less than 1 out of 100 people will die. This means that more than 99 people out of 100 who had the surgery will not die within 3 months.7, 9, 8

Why might your doctor recommend knee replacement surgery?

Your doctor might recommend knee replacement if:

You have very bad arthritis pain, and other
treatments have not helped.

You have lost a large amount of
cartilage.

Your knee pain is keeping you from being active enough to keep up your strength, flexibility, balance, or endurance.

You don't have health problems that would make it
dangerous for you to have surgery.

2. Compare your options

Have knee replacement
surgery

Try other treatment

What is usually involved?

You may be asleep during this
surgery. Or you may be awake but numb from the waist down.

You will probably have a short stay in the hospital, but some people go home the day of surgery.

You
will need several weeks of physical therapy, including exercises you can do at home.

It usually takes people 2 to 3 months to get back to doing their usual activities. But it may take a little longer than that for some people. A full recovery may take 6 to 12 months.

You can try exercise,
weight loss (if you're overweight), medicines, joint injections, or, in some cases, another type of surgery.

You can try using crutches,
braces, and other types of walking support to help ease the stress on your
knee.

What are the benefits?

Most people have much less pain and
are able to do many of their daily activities more easily.

You avoid the risks and side
effects of surgery.

You avoid months of physical therapy, although
exercise is still important.

Your knee won't bend as far as it did before you started
having knee problems.

You may need to avoid activities that put a
lot of stress on the joint, like running or playing tennis.

You may
eventually need another replacement, because the artificial joint can wear
out.

The strong
medicines used for severe pain may cause constipation, mental confusion,
drowsiness, and nausea and vomiting.

Steroid injections can cause
pain and swelling in the knee.

There
are no bad effects from home treatments such as staying at a healthy weight,
exercising, and using heat and cold therapy.

If you decide to have surgery later, and your limited activity has already caused you to lose strength, flexibility, balance, or endurance, it may be harder to return to your normal activities.

Personal stories

Personal stories about knee replacement surgery for osteoarthritis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I've skied competitively since I was 6 years old. In my 20s, I had several knee injuries and surgeries. About 7 years ago, I started having a lot of pain in one knee, and my doctor said the only surgery left to do was to replace the knee. If I have the knee replaced, I won't be able to ski or run or do anything that puts a lot of stress on it. I can't do any of those things now because of the pain anyway. I don't know how I'm going to deal with that, since being an athlete has always been a big part of who I am. I'm worried about having my knee replaced when I'm so young, but with the amount of pain I'm having, I don't see any other choice."

— Chuck, age 45

"The pain in my knees, especially my left one, has gotten steadily worse in the last 20 years. The medicines just weren't working. It got so bad last year that I gave up on my flower garden. My doctor and I discussed knee replacement, but I consider that my last resort. My doctor and I developed a plan of swimming and healthy eating habits that will help me take off the extra weight I've put on. We agree that's the best thing I can do to keep my osteoarthritis from getting worse. We're going to try some different medicines too."

— Esmerelda, age
61

"I feel like I'm too young to have my knee replaced. But I definitely need something other than Tylenol for the pain. I asked my doctor about my other options. She said we can try joint injections and see how that works. I can always have the surgery later if I need it, but I'd sure like to put it off for as long as I can. I'll see if these joint injections make the pain better. My doctor says that as long as I can handle the pain, we can hold off on the surgery."

— George, age 57

"I was an avid tennis player for years, and it finally caught up with my knees. I had an osteotomy years ago, and it helped for a while. But now so much of my time is focused on the pain. I'm an active grandmother with no intention of missing out on my grandkids' activities. I know that surgery will mean a long period of exercising and rehabilitation, but it will be worth it to lose this stiffness and discomfort."

— Jean,
age 71

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have knee replacement surgery

Reasons not to have knee replacement surgery

I want to be able to do low-impact activities, such as swimming and golf, as well as chores and housework.

My knee doesn't really get in the way of the physical activities I like or need to do.

More important

Equally important

More important

I have more bad days than good.

I have more good days than bad.

More important

Equally important

More important

I'm not worried about the chance of needing another replacement surgery later in life.

I'm worried about needing another surgery in 10 or 20 years.

More important

Equally important

More important

I'm ready and willing to do several weeks of physical therapy after the surgery.

I don't want, or I won't be able, to have several weeks of physical therapy.

More important

Equally important

More important

I know that problems sometimes occur with surgery, but getting pain relief and getting back some use of my knee is worth the risk.

I'm very worried about problems from surgery.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having knee replacement surgery

NOT having knee replacement

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Knee replacement surgery should be my first choice if I have osteoarthritis of the knee.

Yes

No

I'm not sure

You're right. Knee replacement surgery should be considered only when other treatments-such as exercise, medicines, physical therapy, and a change in your daily activities-haven't worked to ease your symptoms.

2.
I will be able to return to all my normal activities right after I have this surgery.

Yes

No

I'm not sure

You are right. Rehabilitation after knee replacement surgery is usually intense and requires daily exercises for several weeks.

3.
Although most surgeries last for at least 15 years, I may need to have my knee replaced again.

Yes

No

I'm not sure

You are right. Most knee replacement surgeries last for at least 15 years. But some people do need to have another replacement later.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Mahomed NN, et al. (2005). Epidemiology of
total knee replacement in the United States Medicare population. The Journal of Bone and Joint Surgery. American Volume, 87(6): 1222-1228. http://dx.doi.org/10.2106/JBJS.D.02546 Accessed May 25, 2016.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Mahomed NN, et al. (2005). Epidemiology of
total knee replacement in the United States Medicare population. The Journal of Bone and Joint Surgery. American Volume, 87(6): 1222-1228. http://dx.doi.org/10.2106/JBJS.D.02546 Accessed May 25, 2016.

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